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Introduction: Untreated caries in primary teeth is considered one of the most common epidemic problems around the world. Objectives: The aim of this study was to evaluate the cariostatic efficacy and patient acceptance of nano-silver fluoride (NSF) compared to silver diamine fluoride (SDF) 38% in primary teeth in preschool children. Material and methods: 119 children, with a total of 244 active dentin lesions were randomly assigned into two groups: NSF group included 60 children with 122 lesions, and SDF group consisted of 59 children with 122 lesions. Outcome assessments were performed at 3 weeks and 6 months after treatment using Nyvad criteria to assess the activity of carious lesions. Wong-Baker® faces pain rating scale was used to assess children acceptance for the treatment. Results: After 3 weeks, 94 (77%) lesions in NSF group were arrested, while 110 (90%) lesion were arrested in SDF group (p > 0.05). After six months, the arrest rate in NSF and SDF groups was 67.2% and 79.5%, respectively (p > 0.05). However, the arrest rate of single surface lesions on anterior teeth was higher after six months in both groups (p < 0.05). Furthermore, patient acceptance scores were not statistically different in both groups (p > 0.05). Conclusions: Both SDF and NSF were effective in arresting carious dentine lesions and were accepted by preschool children.

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